What Is Atrial Fibrillation? Symptoms, Diagnosis, and Current Treatment Options

Assoc. Prof. Sezen Bağlan Uzunget, MD
Cardiologist

Do you suddenly feel that your heart is beating rapidly or irregularly? Do you sometimes experience palpitations, shortness of breath, fatigue, or reduced exercise tolerance?

These symptoms may be caused by a heart rhythm disorder called atrial fibrillation (AF).

Atrial fibrillation is one of the most clinically important heart rhythm disorders. It occurs when the atria, the upper chambers of the heart, lose their normal electrical organisation.

While some patients have noticeable symptoms, others have no symptoms at all. Early diagnosis and appropriate treatment are particularly important because AF can increase the risk of stroke.

What Are the Symptoms of Atrial Fibrillation?

Symptoms vary from person to person. Common complaints include:

Palpitations: A sensation of rapid, irregular, or skipped heartbeats
Shortness of breath: Particularly when walking, climbing stairs, or exercising
Weakness and fatigue: Becoming tired more easily during everyday activities
Dizziness: Light-headedness, dimming of vision, or feeling faint
Chest discomfort: Pressure, tightness, or an uncomfortable sensation in the chest
Reduced exercise capacity: Difficulty performing activities that were previously easy

Some patients have no symptoms, and AF is discovered incidentally on an electrocardiogram during a routine examination.

Important: The absence of palpitations does not mean that AF or a risk of stroke is absent.

What Causes Atrial Fibrillation?

Various heart conditions and systemic disorders may contribute to AF.

Major risk factors include:

High blood pressure
Older age
Heart valve disease
Heart failure
Coronary artery disease
Diabetes
Obesity
Sleep apnoea
Excess thyroid hormone
Excessive alcohol intake
Genetic susceptibility

However, AF can also occur in people without significant structural heart disease.

How Is Atrial Fibrillation Diagnosed?

Electrocardiography (ECG) is the main diagnostic method.

When the rhythm disorder is intermittent, an ECG obtained during a clinic visit may be entirely normal.

Further investigations may therefore be needed according to the patient's symptoms.

1. Electrocardiography (ECG)

An ECG records the heart's electrical activity and allows AF to be identified.

2. Holter ECG Monitoring

This records heart rhythm, usually for 24–48 hours or longer. Patients with intermittent palpitations may need longer periods of monitoring.

3. Echocardiography

Echocardiography evaluates the heart's pumping function, atrial size, and heart valves. It is important for identifying structural heart conditions that may accompany AF.

4. Blood Tests

Thyroid function, electrolytes, kidney function, and other necessary laboratory tests are assessed.

Smartwatches and portable rhythm recorders may help detect an irregular heart rhythm. However, a device alert should be confirmed with an appropriate ECG recording.

Is Atrial Fibrillation Dangerous?

One of the most important complications of AF is ischaemic stroke.

Ineffective atrial contraction can cause blood to pool and clots to form, particularly in a region called the left atrial appendage.

A stroke may occur if a clot travels to the arteries supplying the brain.

In some patients, AF may also cause:

Heart failure
Impaired heart function
Reduced exercise capacity
Repeated hospital visits
Reduced quality of life

However, stroke risk is not the same for every patient. It is assessed individually according to age and accompanying medical conditions.

How Is Atrial Fibrillation Treated?

The main treatment goals are preventing stroke, reducing symptoms, preserving heart function, and improving quality of life.

Treatment is tailored to each patient's clinical characteristics.

1. Anticoagulant Medication

Preventing blood clots and stroke in suitable patients is one of the most important aspects of AF treatment.

Medicines called oral anticoagulants may be used for this purpose.

Direct oral anticoagulants such as apixaban, rivaroxaban, dabigatran, and edoxaban are commonly preferred in eligible patients.

Patients with mechanical heart valves or certain patients with moderate-to-severe mitral stenosis require warfarin.

Important: Anticoagulation decisions are not based solely on symptom severity or whether AF is continuous. Thromboembolic and bleeding risks are assessed together.

Aspirin does not replace anticoagulant treatment for preventing AF-related stroke.

2. Heart Rate Control

For some patients, the main aim is to prevent the heart from beating excessively fast.

Beta blockers, certain calcium channel blockers in suitable patients, or digoxin may be used.

The choice depends on the presence of heart failure, blood pressure, heart rate, and other clinical features.

3. Restoring Normal Heart Rhythm

Restoring normal sinus rhythm may be a goal, particularly for patients with palpitations, breathlessness, fatigue, and reduced exercise capacity.

Options include:

Antiarrhythmic medication
Electrical cardioversion
Catheter ablation

4. What Is Electrical Cardioversion?

Electrical cardioversion restores normal rhythm by delivering controlled electrical energy to the heart under appropriate sedation or brief anaesthesia.

It may be selected particularly when AF has started recently or causes significant symptoms.

Before the procedure, AF duration, clot risk, and anticoagulation status must be assessed.

Even after successful cardioversion, AF can recur later.

5. What Is Atrial Fibrillation Ablation?

Catheter ablation is an interventional treatment that aims to electrically isolate the triggers responsible for AF from the surrounding heart tissue.

The procedure is usually performed with specialised catheters introduced through veins in the groin.

Electrical isolation of the pulmonary veins, which play an important role in initiating AF, is the basis of the procedure.

Radiofrequency energy, cryoablation, or pulsed field ablation (PFA) may be used.

In suitable patients with symptomatic AF, ablation may sometimes be considered as the first rhythm-control treatment.

Success depends on AF type and duration, left atrial size, and accompanying conditions. Some patients require a repeat procedure.

Restoration of normal rhythm after ablation does not automatically mean that anticoagulation can be stopped. Continued anticoagulation is determined by the patient's individual stroke risk.

Can Atrial Fibrillation Be Completely Cured?

AF can be controlled for long periods in some patients, allowing normal rhythm to be maintained.

However, it tends to recur. Regular cardiology follow-up remains important even after successful treatment.

Controlling blood pressure, managing weight, exercising regularly, treating sleep apnoea, stopping smoking, and reducing alcohol intake may help reduce recurrence.

Frequently Asked Questions

Does atrial fibrillation cause a heart attack?

AF does not itself mean a heart attack. However, a fast heart rhythm may cause chest pain or increase the heart's oxygen demand in some patients. Coronary artery disease may also coexist.

Can atrial fibrillation stop on its own?

Yes. Particularly in paroxysmal AF, the rhythm may return to normal spontaneously. This does not mean that the condition has disappeared completely.

Can I stop my anticoagulant when my pulse returns to normal?

No. Normalisation of pulse or rhythm alone is insufficient to stop anticoagulation. The decision must be made following a cardiology assessment.

Can people with atrial fibrillation exercise?

Most patients can take part in regular physical activity after appropriate treatment and assessment. Exercise type and intensity should be tailored to the individual's clinical condition.

When is atrial fibrillation an emergency?

Seek urgent medical help if palpitations are accompanied by severe chest pain, marked breathlessness, fainting, very low blood pressure, or signs of stroke such as speech difficulty, facial drooping, or weakness of an arm or leg.

Early Diagnosis and Appropriate Treatment Matter

AF is more than a rhythm disorder that causes palpitations. It may be associated with serious complications, including stroke and heart failure.

Medication, electrical cardioversion, and advanced catheter ablation techniques allow effective management in many patients.

The key is to assess each patient's stroke risk and select an appropriate rate-control or rhythm-control strategy.